call restrictions

[kwyjibo]

I have a question about call,

I know very well of the restrictions on in-house call but what about home call?
Can a resident be on pager/home call q1 for 4 weeks in a row? Per ACGME:

VI.G.3.:
Mandatory Time Free of Duty
“Residents must be scheduled for a minimum of one day free of duty every week (when averaged over four weeks). At-home call cannot be assigned on these free days.

So it seems that residents need to get 1 day completely off (no pager call) in 7. Does that sound right?

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[Crayola227]

Doesn't have to be 1 in 7 first of all.

And yes, those days must be all kinds of call free. That said, in 28 days they could just have a weekend at the start (day 1 & 2) and end (day 27 & 28) be those days, in which case you could work day 3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26 all in a row without breaking the rules. That would be 24 days in a row. The longest stretch I personally witnessed was 21 days, the longest I did personally was 14 or 18 in ICU I think.
Most programs would avoid that long a stretch, not out of any particular altruism but so no one dies, you or pt.

So yes, from what I gather you could be call like that for 24 days in a row, not all 28 in the 4 weeks.

Course you couldn't take home call that would put you over 16 hr on and 8 off as an intern from what I understand.

Maybe someone could chime in about how home call factors in to work hour limits of 80 per week for interns and seniors alike (averaged over month of course, so remember that really means 320 in 28 days as long as any shift for senior isn't longer than 28 (the 24 plus possibly 4) and 10 off after that.)

We could sit here and come up with some pretty nasty schedules as a thought experiment.

 

[kwyjibo]

That would indeed suck

Doesn't have to be 1 in 7 first of all.

And yes, those days must be all kinds of call free. That said, in 28 days they could just have a weekend at the start (day 1 & 2) and end (day 27 & 28) be those days, in which case you could work day 3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26 all in a row without breaking the rules.

The way the consult rotation was set up at my former institution, the call resident would be on home call for 12 days, then 2 days completely off.

 

[rokshana]

so long as you have 4 days off in a 4 week period the guide lines are met.

14 days in a row is the max you can be on home call and not violate ACGME requirements..it would be very unusual to have an intern on home call and unusual in medicine to have home call for residents...this is usually seen with fellowship ...other specialties are different.

 

[Crayola227]

so long as you have 4 days off in a 4 week period the guide lines are met.

14 days in a row is the max you can be on home call and not violate ACGME requirements..it would be very unusual to have an intern on home call and unusual in medicine to have home call for residents...this is usually seen with fellowship ...other specialties are different.

Good to know.

14 days home call. Hours don't count against the limit, right? And hours can be 24/7? (I didn't think this sort of call was common for non-fellows)

What about more shifts in a row than 14 no home call?

 

[rokshana]

Good to know.

14 days home call. Hours don't count against the limit, right? And hours can be 24/7? (I didn't think this sort of call was common for non-fellows)

What about more shifts in a row than 14 no home call?

yes calls can be 24/7 (tends to be the point of home call)...if you come into the hospital during home call, then you have to count those hours towards the 80 hours.

with no home call you can actually work longer in a row, so long as there is 4 days off in a 4 week period and hours average 80 hours over a 4 week period...mostly because other rules have to followed as well...should have 10 hours (must have 8 hours) off duty..no doubt there is probably a way to finagle that so the average is 80h/wk, with 10 hours in between with 1 in 7 averaged over 4 weeks off and work a lot of days in a row.